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  • 1
    Online Resource
    Online Resource
    Demographics of women with female pattern hair loss and the effectiveness of spironolactone therapy
    Elsevier BV ; 2015
    In:  Journal of the American Academy of Dermatology Vol. 73, No. 4 ( 2015-10), p. 705-706
    Details
    In: Journal of the American Academy of Dermatology, Elsevier BV, Vol. 73, No. 4 ( 2015-10), p. 705-706
    Type of Medium: Online Resource
    ISSN: 0190-9622
    URL: Article
    DOI: 10.1016/j.jaad.2015.06.063
    Language: English
    Publisher: Elsevier BV
    Publication Date: 2015
    detail.hit.zdb_id: 2001404-1
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  • 2
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    Clinical challenges in interpreting multiple pathogenic mutations in single patients
    Springer Science and Business Media LLC ; 2021
    In:  Hereditary Cancer in Clinical Practice Vol. 19, No. 1 ( 2021-12)
    Details
    In: Hereditary Cancer in Clinical Practice, Springer Science and Business Media LLC, Vol. 19, No. 1 ( 2021-12)
    Abstract: In the past two decades, genetic testing for cancer risk assessment has entered mainstream clinical practice due to the availability of low-cost panels of multiple cancer-associated genes. However, the clinical value of multiple-gene panels for cancer susceptibility is not well established, especially in cases where panel testing identifies more than one pathogenic variant. The risk for specific malignancies as a result of a mutated gene is complex and likely influenced by superimposed modifier variants and/or environmental effects. Recent data suggests that the combination of multiple pathogenic variants may be fewer than reported by chance, suggesting that some mutation combinations may be detrimental. Management of patients with “incidentally” discovered mutations can be particularly challenging, especially when established guidelines call for radical procedures (e.g. total gastrectomy in CDH1) in patients and families without a classic clinical history concerning for that cancer predisposition syndrome. Case presentation We present two cases, one of an individual and one of a family, with multiple pathogenic mutations detected by multi-gene panel testing to highlight challenges practitioners face in counseling patients about pathogenic variants and determining preventive and therapeutic interventions. Conclusions Ongoing investigation is needed to improve our understanding of inherited susceptibility to disease in general and cancer predisposition syndromes, as this information has the potential to lead to the development of more precise and patient-specific counseling and surveillance strategies. The real-world adoption of new or improved technologies into clinical practice frequently requires medical decision-making in the absence of established understanding of gene-gene interactions. In the meantime, practitioners must be prepared to apply a rationale based on currently available knowledge to clinical decision-making. Current practice is evolving to rely heavily on clinical concordance with personal and family history in making specific therapeutic decisions.
    Type of Medium: Online Resource
    ISSN: 1897-4287
    URL: Article
    DOI: 10.1186/s13053-021-00172-3
    Language: English
    Publisher: Springer Science and Business Media LLC
    Publication Date: 2021
    detail.hit.zdb_id: 2233352-6
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  • 3
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    Alopecia areata in 2 patients treated with dupilumab: New onset and worsening
    Elsevier BV ; 2019
    In:  JAAD Case Reports Vol. 5, No. 8 ( 2019-08), p. 643-645
    Details
    In: JAAD Case Reports, Elsevier BV, Vol. 5, No. 8 ( 2019-08), p. 643-645
    Type of Medium: Online Resource
    ISSN: 2352-5126
    URL: Article
    DOI: 10.1016/j.jdcr.2019.03.019
    Language: English
    Publisher: Elsevier BV
    Publication Date: 2019
    detail.hit.zdb_id: 2834220-3
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  • 4
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    Carcinoma Erysipeloides From Metastatic Cutaneous Squamous Cell Carcinoma Initially Mistaken for Intralymphatic Histiocytosis
    Ovid Technologies (Wolters Kluwer Health) ; 2019
    In:  The American Journal of Dermatopathology Vol. 41, No. 7 ( 2019-07), p. 522-525
    Details
    In: The American Journal of Dermatopathology, Ovid Technologies (Wolters Kluwer Health), Vol. 41, No. 7 ( 2019-07), p. 522-525
    Abstract: Intralymphatic histiocytosis is a rare dermatologic disorder, commonly associated with inflammatory disorders and rarely malignancy. Carcinoma erysipeloides (CE) is a rare pseudoinflammatory cutaneous eruption that resembles soft -tissue infections as result of intralymphatic metastasis and subsequent lymphatic obstruction. Breast carcinoma represents most of the CE cases, but rarely other malignancies are involved. This report discusses a patient with a history of cutaneous squamous cell carcinoma (SCC) of the temple, who was initially diagnosed with intralymphatic histiocytosis located on his upper extremity, resistant to treatment. Further dermatologic and pathologic review later revealed metastatic SCC restricted to the dermal lymphatics, creating a CE reaction, initially obscured by intralymphatic histiocytes. This case highlights the difficulty in diagnosing metastatic carcinoma when the malignant cells are accompanied by a dense histiocytic infiltrate. The case demonstrates a rare presentation of CE due to metastatic cutaneous SCC and highlights the need for persistent investigation when confronted with nonconforming pathology.
    Type of Medium: Online Resource
    ISSN: 0193-1091
    URL: Article
    DOI: 10.1097/DAD.0000000000001369
    RVK:
    XA 18760
    Language: English
    Publisher: Ovid Technologies (Wolters Kluwer Health)
    Publication Date: 2019
    detail.hit.zdb_id: 2041296-4
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  • 5
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    328. Kaposi Sarcoma in High Population ART Utilization Setting: An Observational Study in Botswana
    Oxford University Press (OUP) ; 2019
    In:  Open Forum Infectious Diseases Vol. 6, No. Supplement_2 ( 2019-10-23), p. S174-S175
    Details
    In: Open Forum Infectious Diseases, Oxford University Press (OUP), Vol. 6, No. Supplement_2 ( 2019-10-23), p. S174-S175
    Abstract: Despite population antiretroviral treatment (ART) utilization exceeding UNAIDS 90-90-90 targets, Kaposi sarcoma (KS) remains one of the most prevalent malignancies in Botswana. We sought to examine the characteristics and outcomes of KS in the context of high ART utilization. Methods Consenting patients at one of four oncology centers for KS treatment were enrolled prospectively (October 2010 to March 2019) and followed quarterly for 5 years. Survival was estimated using Kaplan–Meier estimator and predictors assessed with Cox proportional hazards modeling. Results A total of 408 KS patients were enrolled and of those, 396 (97%) were HIV-positive and included in analyses. Median age at diagnosis was 40 years (IQR: 34.1, 46.7) and 247 patients (62%) were male. The median CD4 cell count at the time of KS diagnosis was 253 cells/mL (IQR: 134, 364) and 279 (73%) were receiving ART at the time of KS diagnosis. Among those on ART, the median duration of ART prior to KS diagnosis was 11.9 months (IQR: 2.7, 46.7). The proportion receiving ART prior to KS increased during the surveillance period from 58% to 80% (P 〈 0.001). Of the 248 (62.6%) patients with recent measurement, 91% had HIV-1 RNA 〈 1000 copies/mL. Five-year overall survival was 73% (95% CI 68–78%). In multivariable analysis, Female sex and higher income were associated with improved survival, but not age or CD4 cell count. The duration of ART was significantly associated with survival (P = 0.02), with improved survival for individuals on ART 〈 6 months compared with longer ART (HR 0.54; 95% CI 0.29–0.98). The incidence of KS cases declined by nearly 50%, but has remained relatively stable since 2015. Conclusion Survival rates in this cohort were comparable to other KS cohorts. While KS treatment initially declined with ART expansion, KS remains a significant disease burden in Botswana with 80% of cases occurring among individuals receiving ART. Disclosures All authors: No reported disclosures.
    Type of Medium: Online Resource
    ISSN: 2328-8957
    URL: Article
    DOI: 10.1093/ofid/ofz360.401
    Language: English
    Publisher: Oxford University Press (OUP)
    Publication Date: 2019
    detail.hit.zdb_id: 2757767-3
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  • 6
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    Novel Education Modules Addressing the Underrepresentation of Skin of Color in Dermatology Training
    SAGE Publications ; 2022
    In:  Journal of Cutaneous Medicine and Surgery Vol. 26, No. 1 ( 2022-01), p. 17-24
    Details
    In: Journal of Cutaneous Medicine and Surgery, SAGE Publications, Vol. 26, No. 1 ( 2022-01), p. 17-24
    Abstract: Representative images of pathology in patients with skin of color are lacking in most medical education resources. This particularly affects training in dermatology, which relies heavily on the use of images to teach pattern recognition. The presentation of skin pathology can vary greatly among different skin tones, and this lack of representation of dark skin phototypes challenges providers’ abilities to provide quality care to patients of color. In Botswana and other countries in sub-Saharan Africa, this challenge is further compounded by limited resources and access to dermatologists. There is a need for improved and accessible educational resources to train medical students and local medical providers in basic skin lesion description and diagnosis. Objectives We examined whether online Perceptual and Adaptive Learning Modules (PALMs) composed of representative dark skin images could efficiently train University of Botswana medical students to more accurately describe and diagnose common skin conditions in their community. Methods Year 4 and 5 medical students voluntarily completed PALMs that teach skin morphology, configuration, and distribution terminology and diagnosis of the most common dermatologic conditions in their community. Pre-tests, post-tests and delayed-tests assessed knowledge acquisition and retention. Results PALMs training produced statistically significant ( P 〈 .0001) improvements in accuracy and fluency with large effect sizes (1.5, 3.7) and good retention after a 12.5-21-week median delay. Limitations were a self-selected group of students, a single institution, slow internet connections, and high drop-out rates. Conclusions Overall, population-specific PALMs are a useful tool for efficient development of pattern recognition in skin disease description and diagnosis.
    Type of Medium: Online Resource
    ISSN: 1203-4754 , 1615-7109
    URL: Article
    DOI: 10.1177/12034754211035093
    Language: English
    Publisher: SAGE Publications
    Publication Date: 2022
    detail.hit.zdb_id: 2038674-6
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  • 7
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    Optimizing “best available” medical options when practicing complex medical dermatology in resource-limited settings
    Elsevier BV ; 2016
    In:  Journal of the American Academy of Dermatology Vol. 75, No. 4 ( 2016-10), p. e171-e172
    Details
    In: Journal of the American Academy of Dermatology, Elsevier BV, Vol. 75, No. 4 ( 2016-10), p. e171-e172
    Type of Medium: Online Resource
    ISSN: 0190-9622
    URL: Article
    DOI: 10.1016/j.jaad.2016.05.050
    Language: English
    Publisher: Elsevier BV
    Publication Date: 2016
    detail.hit.zdb_id: 2001404-1
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  • 8
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    Novel Diagnostic Educational Resource: Use of a web-based adaptive learning module to teach inflammatory reaction patterns in dermatopathology to medical students, residents, and fellows
    Elsevier BV ; 2022
    In:  Journal of Pathology Informatics Vol. 13 ( 2022), p. 100099-
    Details
    In: Journal of Pathology Informatics, Elsevier BV, Vol. 13 ( 2022), p. 100099-
    Type of Medium: Online Resource
    ISSN: 2153-3539
    URL: Article
    DOI: 10.1016/j.jpi.2022.100099
    Language: English
    Publisher: Elsevier BV
    Publication Date: 2022
    detail.hit.zdb_id: 2579241-6
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  • 9
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    A retrospective review of patients with Kaposi's sarcoma in Botswana
    Wiley ; 2019
    In:  International Journal of Dermatology Vol. 58, No. 6 ( 2019-06), p. 707-712
    Details
    In: International Journal of Dermatology, Wiley, Vol. 58, No. 6 ( 2019-06), p. 707-712
    Abstract: Despite widespread antiretroviral coverage in Botswana, Kaposi's sarcoma ( KS ) remains among the most common malignancies. To date, adult KS in Botswana is not well characterized. The diagnosis relies on clinical suspicion that is often confirmed by histopathology given the implications of treatment; however, this poses a significant resource burden. Methods We conducted a retrospective review of the cohort of patients biopsied for possible KS at Princess Marina Hospital, the main dermatology referral site in Botswana, from September 2008 through June 2015 to describe the demographics, human immunodeficiency virus (HIV) characteristics, and clinical presentations of these patients. Histopathologic diagnoses were reviewed, and positive predictive value ( PPV ) was used to characterize the accuracy of clinical suspicion of KS . Results A total of 441 patients received 450 biopsies where KS was on the differential diagnosis, and 239 patients (54%) were ultimately diagnosed with KS . The KS cohort was more likely to be male (58% vs. 37%, P   〈  0.001), HIV positive (94% vs. 85%, P   〈  0.05), and have lower CD 4 counts at the time of biopsy (274 cells/μl vs. 362 cells/μl, P   〈  0.05). The PPV of clinical suspicion of KS was 58%. When KS was not histopathologically diagnosed, clinically benign diseases were found in 17%, medically significant conditions requiring alternative therapies in 78%, and life‐threatening diseases in 5%. Discussion Our study reinforces the risk factors in development of KS . The poor PPV supports the important role of histology in KS diagnosis to both ensure appropriate treatment and prevent overtreatment. Improved accessibility to biopsy and augmentation of local dermatopathologic services would likely improve diagnostic accuracy and treatment.
    Type of Medium: Online Resource
    ISSN: 0011-9059 , 1365-4632
    URL: Issue
    URL: Article
    DOI: 10.1111/ijd.2019.58.issue-6
    DOI: 10.1111/ijd.14305
    Language: English
    Publisher: Wiley
    Publication Date: 2019
    detail.hit.zdb_id: 2020365-2
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